MEDICARE: ERIN LEE PRINCE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	29688	AL

General Provider Information

NPI Number	:	1710142088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN LEE PRINCE M.D.

Provider Business Mailing Address
First Line	:	832 ACTON AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 19TH ST S
Second Line	:	JEFFERSON TOWER, DEPT OF RADIOLOGY
City	:	BIRMINGHAM
State	:	AL
Zip	:	35249-6830
Country	:	US
Telephone Number	:	205-934-3166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	06/16/2016

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